Pediatric Ophthalmology, Department of Ophthalmology and Visual Science, University of Iowa Hospital and Clinics, Iowa City, Iowa 52246, USA.
Ophthalmology. 2011 Sep;118(9):1859-64. doi: 10.1016/j.ophtha.2011.02.026. Epub 2011 Jun 12.
To characterize the abnormal head posture (AHP) in children with Down syndrome (DS). The study had 3 aims: to estimate the prevalence of AHP, to describe the distribution of different causes for AHP, and to evaluate the long-term outcomes of AHP in children with DS evaluated at the University of Iowa Hospitals and Clinics between 1989 and 2009.
Retrospective chart review.
Two hundred fifty-nine patient records.
The study data were analyzed using chi-square tests (the Fisher exact test when appropriate) to describe the relationship between the outcome of interest and each study covariate. A predictive logistic regression model for AHP was constructed including all the significant covariates.
Abnormal head posture.
Over the study period, 259 records of patients with DS were identified. Of these, 64 (24.7%) patients had AHP. The most frequent cause of AHP was incomitant strabismus in 17 (26.6%) of 64 patients. The second most frequent cause of AHP was nystagmus, in 14 (21.8%) of 64 patients. For a substantial number of patients with AHP, the cause could not be determined. They represented 12 (18.8%) of all the patients with AHP in this study and 12 (4.6%) of all patients with DS examined. When compared with patients with AHP from a determined cause, this subgroup has a statistically significantly (P = 0.027, Fisher exact test) higher percentage of atlantoaxial instability. In the study population, 9 (14.1%) of 64 patients with AHP had more than 1 cause for AHP. Refractive errors, ptosis, unilateral hearing loss, and neck and spine musculoskeletal abnormalities were responsible for AHP in a small percentage of patients. Of all the patients with AHP, 23 (35.9%) improved their head posture with treatment (glasses or surgery). An additional 6 (9.4%) patients improved their posture spontaneously, over time and without treatment.
The prevalence of AHP in the children with DS evaluated was 24.7%. From this analysis, having strabismus of any kind and particularly incomitant strabismus, nystagmus, or both is highly correlated with the development of an AHP. Almost 19% of DS patients with AHP had no definitive cause that could be determined.
描述唐氏综合征（Down syndrome，DS）患儿的异常头位（abnormal head posture，AHP）。该研究有 3 个目的：估计 AHP 的患病率，描述不同 AHP 病因的分布，以及评估在爱荷华大学医院和诊所（University of Iowa Hospitals and Clinics）于 1989 年至 2009 年间接受评估的 DS 患儿 AHP 的长期结局。
回顾性图表审查。
259 例患者的记录。
采用卡方检验（Fisher 确切检验，适当时）分析研究数据，以描述感兴趣的结局与每项研究协变量之间的关系。构建 AHP 的预测逻辑回归模型，纳入所有有意义的协变量。
异常头位。
在研究期间，共确定了 259 例 DS 患儿的记录。其中，64 例（24.7%）患儿存在 AHP。最常见的 AHP 病因是斜视，在 64 例患者中占 17 例（26.6%）。第二位常见的 AHP 病因是眼球震颤，在 64 例患者中占 14 例（21.8%）。对于相当数量的 AHP 患儿，病因无法确定。在本研究中，这部分患儿占所有 AHP 患儿的 12 例（18.8%），占所有 DS 患儿的 12 例（4.6%）。与有明确病因的 AHP 患儿相比，这一亚组的寰枢椎不稳定比例具有统计学显著意义（P=0.027，Fisher 确切检验）。在研究人群中，64 例 AHP 患儿中有 9 例（14.1%）有不止 1 种 AHP 病因。屈光不正、上睑下垂、单侧听力丧失以及颈部和脊柱骨骼肌肉异常仅在少数患儿中导致 AHP。在所有 AHP 患儿中，23 例（35.9%）通过治疗（眼镜或手术）改善了头位。另外 6 例（9.4%）患儿随着时间的推移，在未经治疗的情况下，头位也得到了改善。
在评估的 DS 患儿中，AHP 的患病率为 24.7%。从本分析来看，任何类型的斜视，尤其是斜视、眼球震颤或两者同时存在，与 AHP 的发生高度相关。将近 19%的 AHP 患儿没有明确的病因。
